Citation Nr: 21022543 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 18-35 674 DATE: April 16, 2021 REMANDED Entitlement to service connection for a neck disability is remanded. Entitlement to a temporary total rating under based on convalescence following September 8, 2017 posterior cervical decompressive laminectomies, total C3, C4, C5 and C6, partial C7 laminectomies with foraminotomies and lateral recess decompression at C3-C4, C4-C5, C5-C6, and C6-C7 is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1962 to December 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2017 rating decision. The Veteran requested a video-conference hearing before a Veterans Law Judge. See July 2018 VA Form 9, Appeal to the Board of Veterans’ Appeals. Later, the Veteran elected to participate in a virtual hearing. Later, the Veteran cancelled the scheduled virtual hearing. Accordingly, the Veteran’s hearing request is deemed withdrawn. 38 C.F.R. § 20.704(e). Unfortunately, the Veteran’s claims must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claims, so he is afforded every possible consideration. 1. Entitlement to service connection for a neck disability is remanded. The Veteran maintains that he is entitled to service connection for a neck disability that had its onset during his active service and/or is secondary to his service-connected acromioclavicular joint osteoarthritis with acromioclavicular joint separation and glenohumeral joint instability. See 38 C.F.R. §§ 3.303, 3.310. The Veteran was afforded a June 2018 Neck (Cervical Spine) Conditions Disability Benefits Questionnaire and corresponding June 2018 medical opinion to evaluate the nature and etiology of his claim for service connection. The examination report states that the Veteran has a diagnosis of degenerative arthritis of the spine. The Veteran advised that his neck disability began with a shoulder injury and that the date of onset of his symptoms was 1963. In addressing secondary service connection, the June 2018 medical opinion states that the Veteran’s claimed disability is less likely than not proximately due to or the result of his service-connected disability as his left shoulder pain has been present since his active service and his neck pain started later. The Board finds that the June 2018 medical opinion is inadequate because it is conclusory and without sufficient rationale. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The examiner did not consider whether the Veteran’s current neck disability was aggravated beyond its natural progression by his service-connected acromioclavicular joint osteoarthritis with acromioclavicular joint separation and glenohumeral joint instability. 38 C.F.R. § 3.310(b); see El-Amin v. Shinseki, 26 Vet. App. 136 (2012) (a medical opinion addressing secondary service connection must discuss both causation and aggravation). The examiner also did not consider whether the Veteran’s current neck disability is directly related to his active service. 38 C.F.R. § 3.303. Therefore, the Veteran’s claim for service connection must be remanded so that he can be afforded adequate medical opinions. Additionally, the Veteran’s service treatment records show that he received medical treatment at the United States Army Hospital in Frankfurt, Germany in December 1963 and January 1964 and Brooke General Hospital, Fort Same Houston, Texas from February 16, 1964, to February 26, 1964 as result of in-service left shoulder recurrent dislocations. It does not appear that the Veteran’s service treatment records contain all of these records as these clinical records may have been filed separately. A remand is required to allow VA to obtain authorization and request these records. Finally, the Veteran was seen at Emergency Care and Treatment at a VA Medical facility in 1991 with complaints of numbness and tingling in his left side and arm. While the treatment record is not dated, it notes that he had been seen on July 18, 1991, and that an EEG had been ordered, but was not yet conducted. Thus, it appears that the Veteran sought Emergency Care and Treatment not long after his July 18, 1991, medical appointment. The record of Emergency Care and Treatment notes that x-rays of the Veteran’s cervical spine were ordered; however, the results of these x-rays are not of record. Therefore, they should be obtained on remand. 2. Entitlement to a temporary total rating based on convalescence following September 8, 2017 posterior cervical decompressive laminectomies, total C3, C4, C5 and C6, partial C7 laminectomies with foraminotomies and lateral recess decompression at C3-C4, C4-C5, C5-C6, and C6-C7 is remanded. The issue of entitlement to a temporary total rating based on convalescence is inextricably intertwined with the claim for service connection being remanded herein, and the claims should be considered together. See 38 C.F.R. § 4.16(a); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, the issue of entitlement to a temporary total rating based on convalescence must be remanded as well. The matters are REMANDED for the following action: 1. Obtain the Veteran’s complete service treatment records, to include all clinical records, to include from United States Army Hospital in Frankfurt, Germany in December 1963 and January 1964 and Brooke General Hospital, Fort Same Houston, Texas in February 1964. 2. Obtain the results of any x-rays of the cervical spine conducted between July 1991 and October 1991 in conjunction with the Veteran’s Emergency Care and Treatment at the VAMC in Muskogee, Oklahoma. See VA Emergency Care and Treatment record dated in 1991; received in Caseflow on October 8, 1991. 3. Obtain the Veteran’s VA treatment records for the period from June 2020 to the present. 4. After the above development is completed, obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s current neck disability. The clinician must review the Veteran’s claims folder. The clinician must: (a.) Opine whether the Veteran’s current neck disability at least as likely as not (50 percent probability or greater) had its clinical onset during his active service, or is otherwise related to his active service. (b.) Opine whether the Veteran’s current neck disability is at least as likely as not (50 percent probability or greater) proximately due to his service-connected acromioclavicular joint osteoarthritis with acromioclavicular joint separation and glenohumeral joint instability. (c.) Opine whether the Veteran’s current neck disability is at least as likely as not (50 percent probability or greater) aggravated beyond its natural progression by his service-connected acromioclavicular joint osteoarthritis with acromioclavicular joint separation and glenohumeral joint instability. NOTE: The clinician is advised that a “permanent worsening” is not required to establish aggravation. Aggravation may include temporary worsening, or flare-ups, of a disability. In providing the above opinions, the clinician should consider: • The Veteran’s service treatment records reflect recurrent left shoulder dislocations during his active service. • The Veteran states that his neck disability began with a shoulder injury and that the date of onset of his symptoms was 1963. See June 2018 Neck (Cervical Spine) Conditions Disability Benefits Questionnaire. • The Veteran provides that he injured his neck during a combat exercise in 1964 in Berlin, Germany and that he subsequently received medical treatment in Frankfurt, Germany and Fort Same Houston, Texas. See March 2018 Decision Review Officer Hearing. * In providing the requested opinion, the examiner must consider the Veteran's description of his/her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? A complete rationale must be provided for all opinions and conclusions reached. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.